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Conduct Disorder in Early Childhood

Nazish Fatima
Research scholar, Dept. of Psychiatric Social Work
Ranchi Institute Of Neuro Psychiatry and Allied Sciences, Ranchi-834006
Conduct Disorder in Early Childhood

Conduct disorders are diagnosed when the child is showing persistent and serious dissocial or aggressive behavior patterns, such as excessive fighting or bullying, cruelty to animals or other people, destructiveness to property, stealing, lying, and truancy from school and running away from home.
According to ICD-10, there are four sub types of Conduct disorders-
  1. Conduct disorder confined to the family context
  2. Un socialsed conduct disorder
  3. Socialized conduct disorder
  4. Oppositional defiant disorder
Conduct disorder confined to the family context:
The dissocial or aggressive behavior is intent on family members and occurs mostly at home or immediate household. Stealing from home and destruction of beloved property of particular family members is typical. Social relationships outside the family are within the normal range.
Un socialized conduct disorder: 
Aggressive and dissocial behavior is connected with the child’s poor relationships with other children and peers groups. There is a lack of close friends, rejection by other children, unpopularity in the school and hostile feelings toward adults.
Socialized conduct disorder: 
The diagnosis is applied when the child is showing aggressive and dissocial behavior, but relationship with children of the same age is adequate.
Oppositional defiant disorder:
Children under age of 9 to 10 year’s; show persistently negativistic, provocative and disruptive behavior. The more aggressive conduct disorders are not present, general law and rights of other people are respected. This type of behavior is often directed towards a new member of the family - i.e. step father etc.
Conduct disorder refers to a set of problem behaviors exhibited by children and adolescents, which may involve the violation of a person, their rights and their property. It is characterized by aggression and sometimes law breaking activities. Conduct disorders are characterized by severe and persistent antisocial behavior. They form the largest single group of psychiatric disorders in older children and adolescents. The essential feature of conduct disorder is persistent abnormal conduct which is more serious than ordinary childhood mischief. The behaviors include disobedience, temper tantrums, physical aggression to siblings or adults and destructiveness. In later childhood, conduct disorder is manifest in the home as stealing, lying and disobedience together with verbal or physical aggression. Conduct disorder is a menacing problem in our country. Among Indian studies, Devasigamani (1990) has reported the prevalence of conduct disorder to be 11.13 %.
Case report:
Index Pt. A.R., was a 7 years old, Islam, male, school dropout, hailing  from  lower-socio-economic status, from rural background of  hindpuri , ranchi, (jharkhand). Born out of Non-Consanguineous parents and stays in joint family. Patient is youngest among three siblings. He has left going Madarsa after his illness. Patient is stubborn in nature. He has developed habit of taking Khaini & Guthka, stealing money & food-grains from house.  For the whole day he used to wander here & there in his village. Sometimes he doesn’t like to play in groups. Early childhood home environment was congenial. Pre morbid temperament was slow-to-warm-up.  Patient’s mother has fluctuating hypertension problem and from last 2 years she is suffering from ill health. Father is nominal head of the family. Mother is the functional head of the family. Family decisions are taken by patient’s mother with advice of her son & her brothers. Switchboard communication is present between patient’s father & mother. Everyone is playing their role adequately except patient’s father. Social, care & financial burden is present. Punishment pattern of family is negative. Patient’s elder brother, beats him, his mother also punished him negatively. In social secondary support is not adequate and primary and tertiary is adequate. Family members are religious; morale values are present in family.
Discussion:
The case report highlights truancy, indiscipline and lying behavior which are the main causes of school drop outs. There is need of behavioral family therapy. In Behavioral family therapy, issues such as family stress, temperament, unproductive habits and negative reinforcement, punishment are addressed so that the family as a whole can learn to adjust the behaviors and attitudes concerning the child and his actions. Along with child should be explained in detail about the drawbacks of substance abuse. He should also be motivated to refrain from substance abuse. Substance use frequently co-occurs with conduct disorder. One of the reported that more than 50% of youths with conduct also met criteria for substance use disorder (Reebye et al. 1995). The co morbidity was higher in the younger (ages 10-13) group. Childhood aggression is a predictor of adolescent drug abuse and delinquency, and delinquency predicts latter drug abuse (Brook et al. 1992).
Conduct disorder children are often incapable of understanding their own behavior, making the therapy very difficult.  By using games and stories one can allow the child to self disclose through some moral stories and within the boundaries of game play. Lahey’s (1999) integrated model for conduct disorder where the child shows features of compositionality, aggression, low harm avoidance, callousness and novelty seeking. It also exhibits the parenting style which leads to conduct disorder. Patterson’s coercive family process model which identifies cycles of negative reinforcement , whereby episodes of child non compliance to parental demand are rewarded by the parent giving in has also been seen here in this case (Patterson,1982). It also exhibits that conduct disorder is associated with poor social skills, isolation and academic difficulties (Hastings et al, 2000).  Many western and Indian study findings where low socio economic classes are significantly correlated with conduct disorder, our patient also belongs to a low socio economic strata.
Management:
There are various interventions for treatment of conduct disorder mostly focused on reduction of severity of the disorder. Skill development child including his family and school environment are the focus of primary management of conduct disorder.
Child Training
Research indicates that as a means of preventing child conduct disorder there is a need for skill development in the area of child competence. Additionally, treatment interventions have been developed to focus on altering the child's cognitive processes. This includes teaching the child problem solving skills, self control facilitated by self statements and developing prosaically rather than antisocial behaviors. Prosaically skills are developed through the teaching of appropriate play skills, development of friendships and conversational skills.
Parents Counseling
Conduct problem typically come from multi problem families in which parents have limited resources for coping with high levels of stress and low levels of social support. Parent management training (PMT) refers to procedure in which parents are trained to alter their child’s behavior in the home. This requires developing several different parenting behaviors such as:
  • Establishing the rules for the child to follow
  • Providing positive reinforcement for appropriate behavior
  • Delivering mild forms of punishment to suppress behavior
  • Negotiating compromises
 The methods to alter parent and child behavior are based on principle and procedure of operant conditioning.
Cognitive Problem-Solving Skills Training
Cognitive process refers to a board class of construct that pertain to how the individual perceives codes and experience the world. Individual who engage in conduct behavior, particularly aggression have been found to distortion in various cognitive process several cognitive process has been used including generating alternative solutions to interpersonal problems (e.g. different ways of handling social situations, identifying the means to  obtain particular ends (e.g. making friends), consequences of one’s actions (e.g. what could happen after a particular behavior), making attributions to others of their actions and perceiving how others feel and expectations of the effects of one’s own actions.
Functional Family Therapy
Functional family therapy (FFT) reflects integrates approach to treatment that has relied on system, behavioral and cognitive views of dysfunctions. Maladaptive behavior evident in the child is the only way some interpersonal functions. The goal of the treatment is to alter interaction and communication pattern in such a way as to foster more adaptive functioning.
School based Programs
There are various preventative programs devised which focus on specific cognitive skill development of a child. School based programs have involved teaching the child interpersonal problem solving skills, strategies for increasing physiological awareness, and learning to use self talk and self control during problem situations. The treatment programs focus on the strategies which are used by the teachers in the class room: Instructions should be simple and very structured; group participation in activities is highly desirable because it makes social contacts possible, choose student of the week etc.
Community Programs
In community based interventions the children are rewarded for attendance and participation in the programs. In their application it is important to provide an integrated multidisciplinary approach to treatment in multiple settings and by providing relevant nutritional supplements, Neuro therapy and behavior training as appropriate.

References
  • Prasad D., (2011) RINPAS Journal, ranchi institute of neuro psychiatry and allied sciences, Ranchi.
  • World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.
  • Deivasigamani TR. Psychiatric morbidity in primary school children: An epidemiological study. Indian J Psychiatry 1990; 32:235-40.
  • Lahey, B.B., Waldman, I.D. & Mc Burnett, K. (1999). The development of anti social behaviour: An integrative causal Journa; of Child Psychology and Psychiatry, 40,669-682.
  • Pattreson ,G.R. (1982). Coercive family process. Eugene,Orego
  • n:Castalia
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